Villous adenoma of the renal pelvis: a common entity at an uncommon location

Villous adenoma is uncommonly seen in the urogenital tract and is even more rarely seen in the upper urinary tract and renal pelvis. Like colorectal adenomas, these neoplasms can transform into adenocarcinoma. The preoperative diagnosis is challenging due to their frequent association with hydronephrosis. Herein, we present the case of a villous adenoma of the renal pelvis in a 62-year-old man presenting with recurrent urinary tract infection. The computed tomography scan showed marked hydronephrosis but no suspicious mass in the right kidney. A laparoscopic right nephrectomy was performed. Gross examination revealed a dilated renal pelvis with an irregular exophytic lesion in the renal pelvis's upper surface. The histopathological examination showed slender, elongated villi with thin fibrovascular cores, consistent with villous adenoma morphology. Isolated villous adenomas have a favorable prognosis. However, the pathologist should undertake a search for an invasive component.

Laparoscopic approach to ureteropelvic junction obstruction in a bifid pelvis

Objective About 10% of renal pelvis are bifids and not so there is a larger index of kidney disease over the normal pelves. The laparoscopy and minimally invasive techniques treat the ureteropelvic junction disease in a low agressive manner. We showed a video of an atypical pyeloplasty of ureteropelvic junction obstruction of a lower unit. The patient is a 33 year-old woman with an intermitent lumbar pain for 3 years. Your image exams showed a bifid left pelvis with a stenosis of the lower unit. We chose to do the fix of this pathology laparoscopically. Materials and Methods We positioned the patient in a right lateral decubitus and 3 trocars was placed, we identify the obstructed junction and a terminolateral anastomosis was performed. Results: The procedure lasted 95 minutes, with little blood loss and the patient was discharged in 2 days. We withdraw the double J catheter after 1 month, a pyelography and a ureteroscopy was performed which showed a pervious anastomosis. After 2 months of follow-up the patient is doing well. Conclusions As far as we know, this is the first case of literature with correction by laparoscopy. The stenosis of ureteropelvic junction in the lower unit of a bifid pelvis can be corrected effectively by laparoscopic surgery. .

Minimally Invasive Pyeloplasty in Horseshoe Kidneys with Ureteropelvic Junction obstruction: A case series

Background and Purpose Horseshoe kidney is an uncommon renal anomaly often associated with ureteropelvic junction (UPJ) obstruction. Advanced minimally invasive surgical (MIS) reconstructive techniques including laparoscopic and robotic surgery are now being utilized in this population. However, fewer than 30 cases of MIS UPJ reconstruction in horseshoe kidneys have been reported. We herein report our experience with these techniques in the largest series to date. Materials and Methods We performed a retrospective chart review of nine patients with UPJ obstruction in horseshoe kidneys who underwent MIS repair at our institution between March 2000 and January 2012. Four underwent laparoscopic, two robotic, and one laparoendoscopic single-site (LESS) dismembered pyeloplasty. An additional two pediatric patients underwent robotic Hellstrom repair. Perioperative outcomes and treatment success were evaluated. Results Median patient age was 18 years (range 2.5-62 years). Median operative time was 136 minutes (range 109-230 min.) and there were no perioperative complications. After a median follow-up of 11 months, clinical (symptomatic) success was 100%, while radiographic success based on MAG-3 renogram was 78%. The two failures were defined by prolonged t1/2 drainage, but neither patient has required salvage therapy as they remain asymptomatic with stable differential renal function. Conclusions MIS repair of UPJ obstruction in horseshoe kidneys is feasible and safe. Although excellent short-term clinical success is achieved, radiographic success may be lower than MIS pyeloplasty in heterotopic kidneys, possibly due to inherent differences in anatomy. Larger studies are needed to evaluate MIS pyeloplasty in this population. .

Neoplasia in horseshoe kidney with pyelic fusion and crossed single ureter

Horseshoe kidney with pyelic fusion and crossed single ureter is a rare anomaly, with only 3 cases described in the literature. Such anomaly can be accompanied by other abnormalities, such as congenital scoliosis and situs inversus totalis. We present one case of this malformation associated with malignant neoplasia, treated with partial nephrectomy.

Down syndrome with transient myeloid leukemia and urological abnormality.

Among the various anomalies associated with Down syndrome, leukemia is quite common. The variant transient myeloid leukemia is seen almost exclusively in the Down syndrome patients. On the other hand, urological anomalies are infrequently found both in the Down syndrome and leukemia patients. We report a case who had the rare combination of a urological anomaly along with Down syndrome and transient myeloid leukemia.

Duplicidade pieloureteral completa e refluxo vésico-ureteral / Complete pieloureteral duplicity and vesico-ureteral reflux

De um total de 41 pacientes portadores de refluxo vésico-ureteral primário que foram tratados com reimplante ureteral com técnica anti-refluxo de agosto de 1984 a outubro de 1993, os autores estudaram retrospectivamente 8 pacientes portadores de duplicidade pieloureteral completa associada a refluxo vésico-uretera1. Nao é objetivo deste trabalho discutir refluxo vésico-ureteral de baixo grau, que na grande maioria dos casos têm boa evoluçao clínica até a cura espontânea apenas com as medidas clássicas de suporte e antibioticoterapia profilática. Objetiva-se demonstrar nossa casuística pessoal frente ao refluxo vésico-ureteral associado à duplicidade pieloureteral completa. Neste trabalho será detalhado o quadro clínico e a etapa de investigaçao diagnóstica com os respectivos achados. É descrita a técnica operatória para correçao de tais malformaçoes e serao apresentados os resultados seguindo parâmetros clínicos e de exames complementares. Dos 8 pacientes estudados, foram reimplantados 19 ureteres com técnica anti-refluxo em 7 pacientes. Foi realizada l nefrectomia parcial-polar inferior em um paciente com pólo inferior destruído pelo refluxo e infecçao. Todos os casos tiveram boa evoluçao após a cirurgia. Nao houve complicaçoes em nenhum caso.

El doble sistema pieloureteral y su patologia / Pathologic pyeloureteral system double

Se presentan 23 pacientes portadores de duplicacion de la via escretora del rinon. Se hace un enfoque practico del problemas aislados como reflujo y ureter ectopico con y sin terocele; planteando a la vez la conducta seguida en casos de: reflujo sobre ureter bifido, meato ureteral malformado sin reflujo radiologico y valoracion funcional del rinon doble

Duplicaçäo pielo-ureteral e hidronefrose do polo superior do rim: diagnóstico pela ecografia pré-natal / Pyeloureteral duplication and hydronephrosis of the upper pole of the kidney: prenatal ultrasonic diagnosis

Os Autores relatam um caso de duplicaçäo pielo-ureteral direta com obstruçäo ao nível da porçäo terminal do ureter, que drena o polo superior, causando hidronefrose, o qual foi diagnosticado atráves da ecografia pré-natal